Press Releases

WASHINGTON, DC – Today, Rep. Mariannette Miller-Meeks (R-Iowa), the Chairwoman of the House Committee on Veterans’ Affairs Subcommittee on Health, delivered the following opening remarks, as prepared, at the start of the subcommittee’s hearing to assess challenges in VA’s current VISN (Veterans Integrated Service Networks) structure:

Good morning. This oversight hearing for the Subcommittee on Health will now come to order.

Before we proceed, I must express my deep disappointment that VA once again failed to send one of the key witnesses we requested. This trend by the Biden administration of not providing the necessary witnesses is unacceptable and undermines the oversight responsibilities of this Subcommittee and Congress as a whole.

We cannot effectively address the critical issues facing our veterans’ healthcare system without the full cooperation of VA.

As a 24-year Army veteran, physician, and former nurse I strongly believe that veterans deserve the utmost quality in care.

Having served in these positions and as the former Iowa Director of Public Health, I have a deep understanding of providing safe and effective care and it remains one of my top priorities in Congress to ensure veterans receive the best healthcare that meets their needs as a patient. 

In 1996, Congress approved VHA’s establishment of the ‘Veterans Integrated Service Networks’ also known as VISNs, as part of a major reorganization to decentralize and improve VA healthcare.

Currently, there are 18 VISNs that manage and oversee 172 medical centers around the country and territories. Each VISN director is responsible for implementing VA policies, providing leadership for comprehensive, coordinated care, and ensuring all facilities in the VISN are adequately staffed and resourced.

The VA’s Under Secretary for Health oversees these directors and is responsible for holding them accountable for the successes and failures of their networks.

Over the years, VISNs have evolved significantly, sometimes leading to inconsistent administrative practices across the networks.

This has resulted in varying treatments, differences in care quality, and accessibility issues for veterans nationwide.

A veteran should be able to walk into any VA medical facility across the country and receive the same quality care.

However, these administrative variabilities across the VISNs have often caused veterans to receive different treatment based on their location rather than their healthcare needs.

The VISNs have shown significant growth in their administrative offices but have lacked corresponding improvements in patient care.

This lack of improvement is not surprising, since VA lacks a comprehensive policy which details the VISN’s roles and responsibilities.

Just this week, the committee received alarming reports from VA’s Office of Inspector General about the VA Eastern Colorado Health Care System. The reports highlighted a lack of proactive oversight from VISN leaders which resulted in employees working in a toxic and unsafe work environment.

VISN leadership also failed to fill vacancies in key clinical positions, which have severely impacted the delivery of care and staff morale.

Notably, the Inspector General concluded there were alleged instances of patient harm due to inadequate physician support and unclear processes.

VA must ensure all VISNs have clearly defined roles and responsibilities or else we will continue to see significant problems in the delivery of care.

That starts with VA’s Undersecretary of Health, Dr. Elnahal holding his senior leaders accountable if they are not delivering on VA’s mission. 

Earlier this month, our Committee heard from Secretary McDonough to discuss the over ten million dollars in bonuses that were improperly awarded to VA’s DC senior executives.

Although most of those bonuses have been clawed back, I understand every VISN Director was offered an identical 25% bonus.

I agree that quality medical administrators deserve to be well paid and rewarded for their service and care, however when every VISN Director gets a huge bonus – regardless of their performance – we are going to have a problem.

Our veterans deserve better, and it is our duty to ensure they receive the high quality, reliable healthcare they have earned.

During today’s hearing, I look forward to examining the current challenges within the VISN structure and identifying actionable solutions so that we can improve the continuity of care for today and tomorrow’s veterans. Additionally, I am eager to explore how implementing comprehensive policies and oversight can enhance patient care and ensure a high standard of healthcare for our veterans.

I would also like to give a warm welcome to Dr. Kizer, VA’s former Under Secretary for Health who designed the VISN system in the 1990’s. Thank you for being here today.

Thank you all for being here and I look forward to our discussion today about this important topic.